Swimmer’s ears – symptoms, causes and risk factors

Swimmer's ears causes

Swimmer’s ears is an infection in the outer ear canal which runs from the eardrum to the outside of the head. It is often brought on by water which remains in our ears after swimming and this is creating a moist environment which can aid the bacterial growth [1]. The most common conditions which can lead to Swimmer’s ears are putting cotton swabs, fingers or other objects in your ears by damaging the thin layer of the skin lining in the ear canal. This condition is also known as otitis externa. The bacteria invading the skin inside your ear canal is the most common cause of this infection. In the most cases swimmer’s ears can be treated with ear drops. Prompt treatment can also help to prevent the complications and more – serious infections.

Symptoms of Swimmer’s ear

Symptoms of Swimmer’s ear are usually mild at first but they may get worse if this infection is not treated or it spreads. Doctors are usually classifying the Swimmer’s ears according to mild, moderate and advanced stages of progression.

Mild signs and symptoms:

  • Some drainage of clear, odorless fluid
  • Mild discomfort that is made worse by pulling on your outer ear (pinna or auricle) or pushing on the little “bump” (tragus) in front of your ear
  • Slight redness inside your ear
  • Itching in your ear canal

Moderate progression:

  • Decreased or muffled hearing
  • You can have a feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
  • Discharge of pus
  • Excessive fluid drainage
  • More extensive redness in your ear
  • Increasing pain
  • More intense itching

Advanced progression:

  • Fever
  • Swelling in the lymph nodes in your neck
  • Redness or swelling of your outer ear
  • Complete blockage of your ear canal
  • Severe pain that may radiate to your face, neck or side of your head

If you are experiencing some symptoms of the Swimmer’s ears even they are mild, you need to see your doctor. If you have severe pain or fever, then you should call your doctor immediately or visit the emergency room.

Swimmer's ears causes

Causes of swimmer’s ears

This ear infection is usually caused by bacteria commonly found in soil and water. Infections which are caused by virus or fungus are less common.

Our ear’s natural defense: Our outer ear canals have natural defenses that help to keep clean and they prevent infection. Protective features include:

  • Downward slope of your ear canal: Your ear canal slopes down slightly from the middle ear to the outer ear, helping water drain out.
  • Glands that secrete a waxy substance (cerumen): These secretions form thin, water – repellent film on the skin inside the ear. Cerumen is also slightly acidic which can help further discourage bacterial growth. In addition, cerumen collects dirt, dead skin cells and other debris and helps move these particles out of the ear. This waxy clump which results is the familiar earwax you find at the opening of your ear canal.

How the infection occurs: If we have this ear infection, then our natural defense has been overwhelmed. Conditions which can weaken our ear’s defenses and promote bacterial growth include:

  • Sensitivity reactions: Hair products or jewelry can cause allergies and skin conditions which can promote infection. [2]
  • Also the excess moisture in our ears can lead to this infection: Heavy perspiration, prolonged humid weather or water that remains in your ear after swimming can create a favorable environment for bacteria. [1,3]
  • Abrasions or scratches in the ear canal: Cleaning your ear with a cotton swab or hairpin, scratching inside your ear with a finger or wearing headphones or hearing aids can cause small breaks in the skin that allows bacteria to grow.

Risk factors: Factors which can increase your risk of Swimmer’s ears are:

  • Skin allergies or irritation from jewelry, hair spray or hair dyes [2]
  • Use of certain devices such as headphones or a hearing aid [1,5]
  • Aggressive cleaning of the ear canal with cotton swabs or other objects [4]
  • Also the narrow ear canal can lead to Swimmer’s ears – for example, in a child – that can more easily trap water
  • When you swim in water with elevated bacteria levels, such as lake rather than a well – maintained pool [1]
  • Swimming

Complications: This infection is not serious if it is treated promptly, but complications can happen such as

  • Long – term infection (chronic otitis externa)
  • Temporary hearing loss
  • Bone and cartilage damage (necrotizing otitis externa)
  • Deep tissue infection (cellulitis)
  • More widespread infection


[1] Schaefer P, Baugh RF. Acute otitis externa: An update. American Family Physician. 2012;86(11):1055-61.

[2] NCH Healthcare System. Swimmer’s ear. 2019. Retrieved from www.nchmd.org/education/mayo-health-library/details/CON-20164010

[3] Wade TJ, Sams EA, Beach MJ, et al. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environmental Health. 2013;12:67.

[4] American Academy of Otolaryngology – Head and Neck Surgery. Acute Otitis Externa (Swimmer’s Ear). Retrieved from www.entnet.org/sites/default/files/AOEGuidelinePLSFinal.pdf

[5] Mazlan R, Saim L, Thomas A, et al. Ear infection and hearing loss amongst headphone users. Malaysian Journal of Medical Sciences. 2002;9(2):17–22.


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